Starting Medical School: Rules of the Road

Posted on July 23, 2011 by marylbrandt

In the next few weeks 17,000 college graduates will start the process of becoming lifelong students of medicine. Medical school is a wonderful, but at times difficult experience. Here are five “rules” that I hope will help with this exciting transition.

1. You can drink from a fire hydrant, but you’ll need to learn how.

The amount of information you are going to be exposed to in medical school is logarithmically more than you had to learn in college. At Baylor (where I teach) we calculate that the first year of medical school is the undergraduate equivalent of 22 hours of course work per semester. It really is like being asked to drink from a fire hydrant. You are going to have to study more, study better and actually use the time in class to learn. The first year or two of medical school may, at times, seem like an obstacle course you have to “get through” to get to the “real stuff”. But these first two years are important; You are learning a new vocabulary… a new language. If you don’t learn the breadth and depth of this new language, when it comes time to apply it to patient care you won’t be “fluent”. By the way, sometime during the first month or two of medical school you will think that a) everyone here is smarter than I am, b) the admissions committee must have made a mistake and I’m not really supposed to be here and c) there is absolutely no way to read all of this material. But, like everyone who has done this before you, will discover that a) you are just as smart as everyone else (sometimes in different ways, but equally effective) b) nobody made a mistake – you really are supposed to be here and c) you have to change the way you study, but you really can learn this much material.

2. Make your bed.

You wanted to become a doctor for a myriad of reasons, but one of them was surely because service to others is important for you. Therefore, you are already primed to sacrifice a lot of your needs for other people. Sacrifice is part of the culture of medicine. But, it’s like a Starling curve… a little sacrifice makes you better, but too much makes you ineffective. “Make your bed” is a simple rule (and action) which helps you remember that you need to take care of your environment, your fitness, your nutrition and your spiritual wellbeing as you are learning how to become a physician.

3. Act like a doctor – starting now.

We (all practicing physicians) see you as a doctor already. I know this is a really hard concept for first year medical students, but it’s absolutely true. You have started your apprenticeship and, unless you are one of the very, very few who change their mind, you will have an MD after your name in 4 years. With all of the joys and privileges that come with this role, there are a few responsibilities to start thinking about as well. Start thinking about your decisions, words and actions and how they might be interpreted by patients or colleagues. It’s no longer acceptable to put anything you want on YouTube, Facebook, Twitter or other social media. How you dress and act when you are in professional settings will be important. You’ll learn more specific details about professional behavior from your professors and colleagues as your training progresses, but the core values of medical professionalism start when you enter the profession, which is now.

4. Kindness matters.

It is remarkable how our paths in medicine cross over and over again. The person sitting next to you on the first day of medical school may be someone who will be an intern with you in 4 years or who will refer you patients 10 years from now. You and your classmates will be going through classes together (like you did in college), but this is different. You are starting your professional life together as well. The camaraderie that results is a gift and is also very important personally and professionally. Don’t blow off the class events. Don’t stay home to study instead of going to class. Go out of your way to meet everyone in your class and really get to know them. Cultivate and nurture these important friendships.

5. Enjoy the journey

You are about to embark on a life changing (and fulfilling) journey. This journey is a privilege and it is very, very special. Take a few minutes everyday to write down the events of the day. The first time you hear a murmur in a heart will be just that – the first time. Take a minute to record what that was like. You are going to have a lot to process as you start studying anatomy – more than just the names of the structure. “Talking” about it in a journal is a great way to make the transition we all make in the anatomy lab. There are also going to be some hilarious stories and events that you’ll forget if you don’t write them down. When you look at them later, you’ll be glad you recorded them with words, photos, or drawings.

“Our study is man, as the subject of accidents or disease. Were he always, inside and outside, cast in the same mould, instead of differing from his fellow man as much in constitution and in his reaction to stimulus as in feature, we should ere this have reached some settled principles in our art.”

William Osler, from Teacher and Student, in Aequanimitas.

How to Study in Medical School (Basic Sciences)

Posted on August 1, 2010 by marylbrandt

Tomorrow is the first day of school for the Baylor medical students so I thought I’d write this to welcome everyone to the fold! That goes for the rest of you at other medical schools as well – you are now part of the field of medicine and we’re glad you are here!

The classes you will have and the way you’ll have to study are completely different from what you experienced in college. So I thought I’d share a little advice to expand on the rules of the road.

1. It all matters.

Unlike college, you don’t get to choose your courses. And, during the first year or two there are no electives – they are all required. So, the first big difference from college is that you don’t get to choose what is important. There are a lot of people who have worked very hard to integrate your curriculum, so the good news is that a lot of it should be related (and therefore easier to learn). One of the nice side effects of this system is that everyone in your class takes every course… so it’s a team effort!

2. Some of it doesn’t matter.

I know this sounds a little contradictory, but bear with me. The first year of medical school is designed to teach you a new language. There is a huge vocabulary to master before you can move on to speaking this new language. Some of the vocabulary is necessary to be fluent, but won’t be critical later when you start seeing patients. Unfortunately, when you start, there is no way to distinguish which is which. Probably the most important thing to take home from this idea is that you have to force yourself to make sure you have the concepts down before you set out to memorize a lot of details.

3. You just spent 4 years learning how to think and now you’ll have to memorize lists.

I think this is one of the hardest parts about transitioning to medical school. It’s not that you won’t be asked to think (trust me!), but the first task is to teach you the language. Unfortunately, that means a lot of memorization. Until you understand the names of the muscles, enzymes, etc it’s hard to learn how they function and… more importantly, what happens when they don’t function the way they should.

4. You have to “use” going to class to learn.

At Baylor (and I assume most medical schools), the basic science classes are video recorded and are available on line. In addition, our students are given notes, slides, handouts, etc for each class. That means that it’s possible to skip class and still have access to all the information. You can learn this way, and do well, but it’s not optimal. In college, most of the time, you heard new information for the first time in the classroom. That was followed by assigned reading, note review, studying, etc to learn the material. You can follow that paradigm in medical school and do well – but it’s not as efficient.

Here’s the ideal way (my opinion) to “use” going to class in medical school.

1. The day before the class, read the notes and assigned reading. You won’t know this material, so don’t get bogged down! This is really more “skimming” that studying. But – when you read, make sure it’s active, not passive. (no “in one ear and out the other”). The best method I have found for active reading is the SQR3 method:

Survey – Look through the notes (and any assigned reading) at the section titles, graphs and tables.
Question – Go through a second time (again pretty superficially) but this time create questions that are likely to be answered in this material and write them down (this part is actually important, so take the time to write them down!).
Read – Read with intention to answer the questions you generated and make some notes for later review. Take the time to actually write the answers to the questions you generated if you found the answers. If not, leave it blank to be answered in class the next day.
Review – Look over (quickly and once) the notes you made and questions you answered.
Recite – This is the one that seems stupid to most people, but it’s not. Based on what is known about learning, reciting the things you really want to remember (out loud, not in your head) every time you review the material really helps with retention. (better not to do this in Starbucks, though…J..)

2. Go to class to hear the answers to your questions, make sure you get answers for any unanswered questions, and to create new questions you didn’t think of. If there is something you don’t understand, or one of your questions wasn’t answered – ask! I tell my classes all the time that there is no such thing as a stupid question. If you are thinking it, chances are there are at least 10 other people wondering the same thing. Ask out loud (to help the other 10 people) or, if you prefer, ask the professor after class. I also ask my students to email me questions they have or things that weren’t clear from my lecture. I post their questions (with the answer) on the first year class listserve (without their names) so everyone in the class benefits from the question.

3. In the afternoon or evening, after your classes are over, sit down with your notes, the handouts and any assigned reading. Study it. (The SQR3 method ) Then make a one page summary for each of the lectures – concentrate on the concepts and what you think is most important. For anatomy, this might be a drawing rather than words. This will be the sheet you use to review before exams, so make sure it has the basic concepts as well as the important “vocabulary” (i.e. memorization) that you’ll need to know. Take the time to list what you think might be on an exam i.e. what questions you would ask if you were writing the exam. Force yourself to stick to one page. It’s how you process and condense your detailed notes into the overview and big points that you will need later in the clinics.

4. Review the material again the next day and a week later. This review (which does not take long) is the most important step. It truly is what makes the difference between learning the information and cramming before the test.

What this means, as an example, is that on Wednesday afternoon/night you will

Review all the lectures from Wednesday with the goal of making a single review sheet for each lecture (this is real studying)
Prepare for all the lectures on Thursday by actively skimming (note, this is not really studying) the notes and assigned reading for the lectures
Quickly review your notes from Tuesday’s lectures
Quickly review your notes from the lectures 1 week before

By the way – even though you will be working very hard, this is going to be a wonderful year! Learning a foreign language is exhausting but exhilarating. You have worked hard to get here, and you will do well. Like everyone else who has gone through this, you will become fluent – and learn that it is a remarkably beautiful language.

Starting Medical School: Rules of the Road

Posted on May 16, 2010 by marylbrandt

If you are reading this because you are preparing to start medical school – welcome! You are now part of one of the most noble professions in the world. You are no longer just a student, you are part of a profession… as of now.

Medical school is a wonderful, but at times difficult experience. As you start this fantastic journey, there are a few “rules” I think might help:

1. You can drink from a fire hydrant, but you’ll need to learn how.

The amount of information you are going to be exposed to in medical school is logarithmically more than you had to learn in college. It really is like being asked to drink from a fire hydrant. You are going to have to study more, study better and actually use the time in class to learn. (more posts to follow with concrete tips on how to do this.) But – here’s the good news. You’ll be able to do it. Everyone who has gone through this has thought at various times that a) everyone here is smarter than I am, b) the admissions committee must have made a mistake and I’m not really supposed to be here and c) there is absolutely no way to read all of this material. And… we all discover that a) we are just as smart as everyone else (sometimes in different ways, but all effective) b) nobody made a mistake – we really are supposed to be here and c) you have to change the way you study, but you really can learn this much material.

2. Make your bed.

You wanted to become a doctor for a myriad of reasons, but one of them was surely because service to others is important for you. Therefore, you are already primed to sacrifice a lot of your needs for other people. Sacrifice is part of the culture of medicine. But, it’s like a Starling curve… a little sacrifice makes you better, but too much makes you ineffective. Doctors are notorious for this; we forget that if we don’t take care of ourselves, we really can’t take care of others. “Make your bed” is a simple rule (and action) which helps you remember that you need to take care of your environment, your fitness, your nutrition and your spiritual wellbeing as you are learning how to become a physician.

3. Act like a doctor.

We (all practicing physicians) see you as a doctor already. I know this is a really hard concept for first year medical students, but it’s absolutely true. You have started your apprenticeship and, unless you are one of the very, very few who change their mind, you will have an MD after your name in 4 years. With all of the joys and privileges that come with this role, there are a few responsibilities to start thinking about as well. Start thinking about your decisions, words and actions in this context. You’ll learn a lot of specific details about professional behavior as your apprenticeship goes on, like protecting patient confidentiality, peer review, etc., but the core values of professionalism start when you enter the profession, which is now.

4. Kindness matters.

5. Enjoy the journey

The first year or two of medical school may, at times, seem like an obstacle course you have to “get through” to get to the “real stuff”. The basic science curriculum is not a rite of passage! It turns out that even the “trivia” (or at least that’s what it will seem like) is important. You are learning a new vocabulary… a new language. If you don’t learn the breadth and depth of this new language, when it comes time to apply it to patient care you won’t be “fluent”.